Angina

Question 1

describe Stable angina

Answer 1

• pain while exercising and then the pain goes away when they stop exercising

Question 2

what do you look for in a chest pain assessment

Answer 2

• how long have you had it
• how long doesn’t last
• where is it – localised generalised radiation
• what is it like
• what provokes and relives it

Question 3

what are non cardiac chest pain problems

Answer 3

• digestive – heartburn, swallowing disorders
• neurogenic - cervical/thoracic spine, shingles
• pulmonary – pleurisy, pulmonary fibrosis
• bony pain – rib fracture, 2nd degree deposits

Question 4

what are the causes of angina

Answer 4

• an imbalance between MI supply and demand

Question 5

what can cause a decrease in myocardial oxygen supply

Answer 5

• coronary artery disease – atherosclerosis (usual cause), spasm, vasculitic disorders, post radiation therapy
• severe anaemia

Question 6

what can cause a need for oxygen and thus an increase in myocardial oxygen demand

Answer 6

• left ventricular hypertrophy – hypertension, aortic stenosis, aortic regurgitation, hypertrophic cardiomyopathy
• right ventricular hypertrophy – pulmonary hypertension, pulmonary stenosis
• rapid tachyarrhythmias

Question 7

what are the non invasive tests for angina

Answer 7

• functional testing for evidence of ischaemia – ETT, SPEC, Stress echo, Stress cMR
• anatomic testing for evidence of obstructive disease CTCA

Question 8

what does the NICE guidelines say around the clinical assessment of angian

Answer 8

1. Central chest discomfort lasting 5-15 minutes
2. Provoked by exertion or emotional stress
3. Relieved by rest or nitrate
   - non anginal pain 1 or less than 1 - no diagnostic testing
   - atypical angina 2 characteristics
   - typical angina 3 characterics
   - the last to are referred to diagnostic testing, CTCA

Question 9

what drugs can increase oxygen delivery by increasing coronary flow thereby providing symptom relief

Answer 9

• Nitrates
  • CaBs
  • Nicorandil
  • Revasc – bypass surgery or stenting

Question 10

what drugs can reduce oxygen demand by decreasing heart rate thereby providing symptom relief

Answer 10

• BB

* ivabridine

Question 11

what drugs can reduce oxygen demand by decreasing LV wall tension thereby providing symptom relief

Answer 11

BB
•	 Nitrates
•	 Nicorandil
•	 CaBs
•	 ranolazine

Question 12

what drugs can reduce oxygen demand by decreasing contractility thereby providing symptom relief

Answer 12

• BB

* CaBs

Question 13

what drugs can reduce oxygen demand by modifying energy metabolism thereby providing symptom relief

Answer 13

trimetazidine

Question 14

what are the first line treatments

Answer 14

• beta blockers

- calcium channel blockers

Question 15

what is given as 2nd degree prevention for angina

Answer 15

• aspirin → all patients
• statins → all patients - to target 4 and 2
• ACE-I → if other indications (HT/DM)
• P2Y12 receptor antagonist→ all patients after PCI or if intolerant of aspirin